Is Spectral-Domain Optical Coherence Tomography Essential for Flexible Treatment Regimens with Ranibizumab for Neovascular Age-Related Macular Degeneration?

Purpose. To evaluate the ability of spectral-domain optical coherence tomography to detect subtle amounts of retinal fluid when the choroidal neovascularization is detected as inactive via time-domain optical coherence tomography and clinical examination in neovascular age-related macular degeneration (nAMD) patients.Methods. Forty-nine eyes of 49 patients with nAMD after ranibizumab treatment were included in this cross-sectional, prospective study. All patients were imaged with TD-OCT and SD-OCT at the same visit one month after a ranibizumab injection. The presence of subretinal, intraretinal, and subretinal pigment epithelium fluid (subRPE) in SD-OCT was evaluated; also mean central retinal thickness (CRT) and the rate of vitreoretinal surface disorders detected via the two devices were evaluated.Results. The mean CRT via TD-OCT and SD-OCT was218.1±51.3and325.7±78.8microns. Sixteen patients (32.6%) showed any kind of retinal fluid via SD-OCT. In detail, 8 patients (16.3%) showed subretinal fluid, 10 patients (20.4%) showed intraretinal fluid, and 3 patients (6.1%) showed SubRPE fluid. The ability of detecting vitreoretinal surface disorders was comparable between the two devices, except vitreomacular traction.Conclusion. SD-OCT is essential for the nAMD patients who are on an as-needed treatment regimen with ranibizumab. Only TD-OCT and clinical examination may cause insufficient treatment in this group of patients.

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Spectral-Domain Optical Coherence Tomography Associations of Neovascular Conversion in Age-Related Macular Degeneration

Journal of VitreoRetinal Diseases ◽

10.1177/2474126418756405 ◽

2018 ◽

Vol 2 (2) ◽

pp. 69-78

Author(s):

Siqing Yu ◽

Sebastian Wolf ◽

Marion R. Munk ◽

Martin S. Zinkernagel ◽

Andreas Ebneter

Keyword(s):

Optical Coherence Tomography ◽

Macular Degeneration ◽

Pigment Epithelium ◽

Age Related Macular Degeneration ◽

Spectral Domain ◽

Optical Coherence ◽

Time Points ◽

Age Related ◽

Fellow Eyes ◽

Sd Oct

Purpose: To identify spectral-domain optical coherence tomography (SD-OCT) features associated with exudative conversion in fellow eyes of patients treated for neovascular age-related macular degeneration (nAMD) in their first eye. Methods: Retrospective observational study. Spectral-domain optical coherence tomography images of converting fellow eyes (study eyes) from 83 patients with nAMD were compared to fellow eyes of age- and sex-matched patients with nAMD who did not convert (control eyes). Parameters related to drusen, pigment epithelium detachment, hyperreflective foci (HRF), retinal pigment epithelium atrophy, small cystic cavities, and vitreoretinal interface were graded. Longitudinal analysis in study eyes and cross-sectional comparison with control eyes at the last 3 semiannual visits before nAMD conversion were performed. Results: For most biomarkers, the prevalence in study eyes increased and imaging findings worsened more than in control eyes. Drusen size and reticular pseudodrusen presence were significantly greater in converting eyes at all 3 time points. Outer retinal small cystic cavities were significantly more common in study eyes shortly before conversion. Binary logistic regression revealed that biggest drusen width was significantly associated with nAMD at all 3 time points (odds ratio [OR] > 1.010; P < .001). The presence of soft drusen was strongly associated with nAMD 18 months before conversion (OR: 7.034; P = .040). Clustering HRF in the inner retina were significantly associated with nAMD both 12 (OR: 1.324; P = .049) and 6 months (OR: 2.161; P = .035) before conversion. Conclusions: Emergence of HRF in fellow eyes, particularly in the inner retina, are sensitive SD-OCT features indicating conversion to exudative disease in patients treated unilaterally for nAMD.

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Morphological Predictive Features on Spectral-Domain Optical Coherence Tomography for Visual Outcomes in Neovascular Age-Related Macular Degeneration Treated with Ranibizumab

BioMed Research International ◽

10.1155/2018/7438083 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Georges Azar ◽

Benjamin Wolff ◽

Flore De Bats ◽

Jeremie Halfon ◽

Mate Streho ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Macular Degeneration ◽

Morphological Features ◽

Age Related Macular Degeneration ◽

Spectral Domain ◽

Prognostic Indicators ◽

Optical Coherence ◽

Multicentric Study ◽

Age Related ◽

Sd Oct

Purpose. To identify spectral-domain optical coherence tomography (SD-OCT) predictive morphological features for the outcome of Ranibizumab therapy for neovascular age-related macular degeneration (AMD). Methods. This is a retrospective multicentric study that involved 64 eyes with naïve AMD. Patients who received three monthly intravitreal injections of Ranibizumab were stratified into (1) “responders” [≥ 5 letters gain on Early Treatment Diabetic Retinopathy Study (ETDRS) scale] and (2) “nonresponders” (< 5 letters gain). Best-corrected visual acuity (BCVA) and SD-OCT morphological features were compared at baseline and one month after three consecutive injections of Ranibizumab. Univariate and multivariate analyses were carried out to correlate these morphological features with the change in BCVA. Results. Among the 64 patients enrolled, 40 (62.5%) were “responders” and 24 (37.5%) “nonresponders”. Age, sex, and BCVA were comparable between both groups. A multivariate correlational analysis found that subfoveal choroidal thickness (SFCT) and the presence of pigment epithelial detachment (PED) > 250 μm at baseline were two independent prognostic indicators of final BCVA. No other SD-OCT morphological studied features seem to affect final BCVA after Ranibizumab treatment. Conclusion. SFCT and the presence of PED > 250 μm are two significant biomarkers that may predict improvement after Ranibizumab therapy for AMD. These markers may guide ophthalmologists' treatment decision under financial constraints and limited time.

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Low-Reflectivity Drusen With Overlying RPE Damage Revealed by Spectral-Domain OCT: Hint for the Development of Age-Related Macular Degeneration

Frontiers in Medicine ◽

10.3389/fmed.2021.706502 ◽

2021 ◽

Vol 8 ◽

Author(s):

Shasha Yang ◽

Zongyin Gao ◽

Haijiang Qiu ◽

Chengguo Zuo ◽

Lan Mi ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Macular Degeneration ◽

Retinal Pigment ◽

Morphological Characteristics ◽

Age Related Macular Degeneration ◽

Spectral Domain ◽

Optical Coherence ◽

Age Related ◽

Sd Oct

Purpose: To observe the relationship between the characteristic changes in the drusen morphology revealed by the spectral-domain optical coherence tomography (SD-OCT) and the progression of age-related macular degeneration (AMD).Methods: A total of 380 drusen in 45 eyes in 35 patients with the intermediate drusen were longitudinally followed up every 6 months by SD-OCT for a period of 24 months. The drusen were divided into the dynamic group and stable group according to the following parameters: number, volume, concurrent retinal pigment epithelium (RPE)/ellipsoid zone (EZ) damage, and the development of advanced AMD. The morphological characteristics of the progressive or stable drusen were further analyzed. Odds ratios (ORs) and the risk for the drusen progression were calculated.Results: The level of interobserver and intraobserver agreement for each drusen tomographic morphological parameters ranged from 82.7 to 90%. At the end of an average follow-up of 15.92 ± 6.99 months, six patients developed choroidal neovascularization and no patients developed geographic atrophy. Finally, 139 drusen changed and 241 drusen remained stable. The drusen with low reflectivity (p < 0.001; OR: 5.26; 95% CI: 2.24–12.36), non-homogeneity without a core (p < 0.001; OR: 4.31; 95% CI: 2.08–8.92), RPE damage (p < 0.001; OR: 28.12; 95% CI: 9.43–83.85), and the EZ damage (p < 0.001; OR: 14.01; 95% CI: 5.28–37.18) were significantly associated with active change; the drusen with low reflectivity (p = 0.01; OR: 2.95; 95% CI: 1.29–6.75) and decreased overlying RPE reflectivity (p < 0.001; OR: 21.67; 95% CI: 9.20–51.02) were the independent predictors for progression. The drusen with high reflectivity were significantly associated with stabilization (p = 0.03; OR: 0.17; 95% CI: 0.04–0.84).Conclusion: Spectral-domain optical coherence tomography is an optimized, accurate, and efficient method to follow-up the drusen. The intermediate non-exudative AMD prognosis of the patient was most strongly correlated with the drusen reflectivity and disruption of the overlying RPE layer. The drusen with low reflectivity and overlying RPE damage were more likely to progress and required frequent follow-up.

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ASSESSMENT OF EARLY CHANGES IN SPECTRAL DOMAIN-OPTICAL COHERENCE TOMOGRAPHY (SD-OCT) AFTER INITIATION OF TREATMENT WITH INTRAVITREAL AFLIBERCEPT (EYLEA®) OVER A 12-WEEK PERIOD FOR PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

Retina ◽

10.1097/iae.0000000000002910 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Jean-François Korobelnik ◽

Eric H. Souied ◽

Hassiba Oubraham ◽

Sam Razavi ◽

Martine Mauget-Faÿsse ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Macular Degeneration ◽

Age Related Macular Degeneration ◽

Spectral Domain ◽

Optical Coherence ◽

Age Related ◽

Intravitreal Aflibercept ◽

Sd Oct

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Anti-VEGF Treatment and Optical Coherence Tomography Biomarkers in Wet Age-Related Macular Degeneration

10.5772/intechopen.97689 ◽

2021 ◽

Author(s):

Maja Vinković ◽

Andrijana Kopić ◽

Tvrtka Benašić

Keyword(s):

Optical Coherence Tomography ◽

High Resolution ◽

Macular Degeneration ◽

Real World ◽

Subretinal Fluid ◽

Age Related Macular Degeneration ◽

Optical Coherence ◽

Anti Vegf ◽

Age Related ◽

Sd Oct

Age-related macular degeneration (AMD) is one of the most common causes of severe visual loss in middle and old-age population, and often leads to serious deterioration in quality of life. Currently, the first-line treatment for neovascular AMD (nAMD) are intravitreal injections of anti-vascular endothelial growth factor (VEGF) medications, including bevacizumab, ranibizumab, and aflibercept and also latest commercially available drug, brolucizumab. During initial examination and imaging and treatment follow-up for patients with nAMD, optical coherence tomography (OCT) is used to predict and assess the therapeutic response and guide the treatment. Several OCT-based biomarkers, including the central subfoveal thickness (CSFT), the presence of intraretinal cysts (IRCs) or subretinal fluid (SRF), and the presence of pigment epithelial detachment (PED), were found to influence baseline visual acuity or visual improvements. Recent analyses of large randomized control trials (RCTs) summarized the usefulness of these OCT-based biomarkers. However, many of these early studies relied on time-domain OCT to evaluate the retinal structures thus providing less precise evaluation of the retinal details. After introduction of spectral-domain OCT (SD-OCT) which provided high resolution images, recent studies offered new insights in specific morphological changes and their different impact on visual function in nAMD. For example, these advancement in resolution offered new classification of IRCs into degenerative and exudative which impacts treatment strategy and final outcome in the treatment of nAMD. Moreover, the recent data disclose a substantial difference between RCTs and real-world studies regarding the response to anti-VEGF therapy. In conclusions, IRCs and PED are associated with poor visual improvement in nAMD in a realworld setting. Both IRCs and SRF responded better than PED to anti-VEGF therapy. These observations mandate large longitudinal studies focusing on the usefulness of these high resolution SD-OCT biomarkers in real-world situations.

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